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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w m o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � � U1 <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 _ <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNERI t _ r 1 aS TELEPHONE <br /> HOME ADDRESS /JD✓dyl .. ./'IC.. .—. A ✓L�liA/ / 7. /h / �A/ S S-,v <br /> 5� <br /> EMERGENCY/FIRE NUMBER � C�-L--7 ROAD NAME ' <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR �,� Ne <br /> o (� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE_�'�// ADDITION— <br /> SANITARY— <br /> DDITION SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> z <br /> STRUCTURE/ADDITION USE:� '1 (W\P / `7 o <br /> / ' ' <br /> (Home/Cabin),Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR i <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ,t <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o $ <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m y: <br /> North (N). y ° <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. A <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be x <br /> signed and dated by the owner. �J u, <br /> J � 8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- I ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 64 <br /> 2. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 70 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. p <br /> y g c y r D £ <br /> 7. A mg� dcm � m <br /> .0 <, fn, '2 N p g Ip <br /> 8. 0 s = n <br /> G y : <br /> �� ': m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i O <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of N y p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 5,0 o : <br /> that this Information I am providing will be railed upon by the County of Burnett Wisconsin In determining whether to is. <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> 3 : x : <br /> authorized person to h e access to the above described premises at any reasonable time for the purpose of Inspection. r v m <br /> m <br /> B <br /> SIGN HERE <br /> (signature of owner o building contractor) (date) <br /> ZONING ADMINISTRATOR1 '• i i <br /> N N N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> 0 $ o $oo oo to <br />